Abstract

Background

While the association of human papillomavirus (HPV) with cervical cancer is well established,
the influence of HIV on the risk of this disease in sub-Saharan Africa remains unclear.
To assess the risk of invasive cervical carcinoma (ICC) associated with HIV and HPV
types, a hospital-based case-control study was performed between September 2004 and
December 2006 in Kampala, Uganda. Incident cases of histologically-confirmed ICC (N=316)
and control women (N=314), who were visitors or care-takers of ICC cases in the hospital,
were recruited. Blood samples were obtained for HIV serology and CD4 count, as well
as cervical samples for HPV testing. HPV DNA detection and genotyping was performed
using the SPF10/DEIA/LiPA25 technique which detects all mucosal HPV types by DEIA and identifies 25 HPV genotypes
by LiPA version 1. Samples that tested positive but could not be genotyped were designated
HPVX. Odds ratios (OR) and 95% confidence intervals (CI) were calculated by logistic
regression, adjusting for possible confounding factors.

Results

For both squamous cell carcinoma (SCC) and adenocarcinoma of the cervix, statistically
significantly increased ORs were found among women infected with HPV, in particular
single HPV infections, infections with HPV16-related types and high-risk HPV types,
in particular HPV16, 18 and 45. For other HPV types the ORs for both SCC and adenocarcinoma
were not statistically significantly elevated. HIV infection and CD4 count were not
associated with SCC or adenocarcinoma risk in our study population. Among women infected
with high-risk HPV types, no association between HIV and SCC emerged. However, an
inverse association with adenocarcinoma was observed, while decrease in CD4 count
was not associated with ICC risk.

Conclusions

The ORs for SCC and adenocarcinoma were increased in women infected with HPV, in particular
single HPV infections, infections with HPV16- and 18-related types, and high-risk
HPV types, specifically HPV16, 18 and 45. HIV infection and CD4 count were not associated
with SCC or adenocarcinoma risk, but among women infected with high-risk HPV types
there was an inverse association between HIV infection and adenocarcinoma risk. These
results suggest that HIV and CD4 count may have no role in the progression of cervical
cancer.